FAQ Directory

Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can  ask a question through My NCQA.

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11.15.2021 Removal of APM Example In the 2022 NCQA standards for QI 4, Element A, factor 6, the HEDIS measure Metabolic Monitoring for Children and Adolescents on Antipsychotics was removed as an example for the requirement. Why? Can it still be used to fulfill the requirement?

The APM measure may be used if it is relevant to the population. Because it applies to children and adolescents, it was removed from the factor 6 examples to align with the exception (factor 6 is NA if the organization’s membership does not include adult members).

HP 2022

11.15.2021 UM 3, Element A, Notification to Members May notifications sent to members be used as materials to satisfy UM 3, Element A, factors 4 and 5?

Yes. Notifications (e.g. newsletters, member letters) sent to members indicating the TDD/TTY and language assistance services that are available are acceptable materials for factors 4 and 5.

HP 2022

11.15.2021 General Guideline 18: Deceased Members How should we apply the “deceased members” exclusion in General Guideline 18: Deceased Members for episode-based measures?

The guideline for deceased members (General Guideline 18) is a member-level exclusion. For episode-based measures, if one event does not meet numerator criteria, and the organization chooses to use this optional exclusion, remove all member events/episodes from the measure.

HEDIS 2021

11.15.2021 Comprehensive Diabetes Care If medical record documentation indicates that an eye exam result is “unknown,” does this qualify as a result when reporting the eye exam indicator of the CDC measure or the EED measure?

No. Documentation of an “unknown” eye exam result does not meet criteria for hybrid reporting for the eye exam indicator of the CDC measure or the EED measure.

HEDIS 2022

10.15.2021 General Guideline 32: Obtaining Information for the Systematic Sample Should the number of numerator events by administrative data in the eligible population (before exclusions), the number of required exclusions and the current year’s administrative rate (before exclusions) data elements change with a data refresh after the sample has been drawn?

No. The number of numerator events by administrative data in eligible population, the number of required exclusions and the current year’s administrative rate data elements must remain frozen at the time of sampling and do not change with data refresh.

HEDIS 2021

10.15.2021 General Guideline 32: Obtaining Information for the Systematic Sample Should the number of numerator events by administrative data in the eligible population (before exclusions), the number of required exclusions and the current year’s administrative rate (before exclusions) data elements change with a data refresh after the sample has been drawn?

No. The number of numerator events by administrative data in eligible population, the number of required exclusions and the current year’s administrative rate data elements must remain frozen at the time of sampling and do not change with data refresh.

HEDIS 2022

10.15.2021 Transitions of Care The TRC measure includes a summary of change (SOC) to indicate that it the value is stratified. Should this be removed from the SOC?

Yes. Remove the SOC text that reads, “Revised the Reporting Instructions for the ‘NumeratorByAdminElig’ data element in Table TRC-3: Data Elements for Transitions of Care to ‘For each Metric and Stratification.’” Organizations reported “NumeratorByAdminElig” by age stratification in the past, so this is not a change to the measure for MY 2020 & MY 2021 reporting.

HEDIS 2021

10.15.2021 Transitions of Care The TRC measure includes a summary of change (SOC) to indicate that it the value is stratified. Should this be removed from the SOC?

Yes. Remove the SOC text that reads, “Revised the Reporting Instructions for the ‘NumeratorByAdminElig’ data element in Table TRC-3: Data Elements for Transitions of Care to ‘For each Metric and Stratification.’” Organizations reported “NumeratorByAdminElig” by age stratification in the past, so this is not a change to the measure for MY 2020 & MY 2021 reporting.

HEDIS 2022

10.15.2021 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents The WCC measure includes a summary of change (SOC) to indicate that the value is stratified. Should this be removed from the SOC?

Yes. Remove the SOC that reads, “Revised the Reporting Instructions for the ‘NumeratorByAdminElig’ data element in Table WCC-1/2 to read ‘For each Metric and Stratification.’” Organizations reported “NumeratorByAdminElig” by age stratification in the past, so this is not a change to the measure for MY 2020 & MY 2021 reporting.

HEDIS 2021

10.15.2021 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents The WCC measure includes a summary of change (SOC) to indicate that the value is stratified. Should this be removed from the SOC?

Yes. Remove the SOC that reads, “Revised the Reporting Instructions for the ‘NumeratorByAdminElig’ data element in Table WCC-1/2 to read ‘For each Metric and Stratification.’” Organizations reported “NumeratorByAdminElig” by age stratification in the past, so this is not a change to the measure for MY 2020 & MY 2021 reporting.

HEDIS 2022

9.15.2021 Well-Child Visits in the First 30 Months of Life (W30) Does a well child visit with an OB/GYN meet criteria for the W30 measure?

Yes, if the OB/GYN is considered to be a PCP by the health plan (i.e., offers primary care medical services). Refer to Appendix 3 of HEDIS Measurement Year 2022 for the definition of “PCP.”

HEDIS 2022

9.15.2021 Follow-Up After Emergency Department Visit for Substance Use (FUA) It appears that the medication tables for the Alcohol Use Disorder Treatment Medications List and the Opioid Use Disorder Treatment Medications List needed to identify pharmacotherapy dispensing events in the numerator are not included in the FUA measure. Where can they be found?

The medication tables for the Alcohol Use Disorder Treatment Medications List and the Opioid Use Disorder Treatment Medications List were inadvertently omitted from the measure specifications. The full medication lists are included in the MY 2022 Medication List Directory (MLD). The medication tables can also be found in the following measures: Follow-Up After High-Intensity Care for Substance Use Disorder, Identification of Alcohol and Other Drug Services, Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment.  

HEDIS 2022